Clinical Outcome of Conservative Treatment for Osteoporotic Compression Fractures in Thoracolumbar Junction / 대한척추외과학회지

ABSTRACT

STUDY DESIGN: A retrospective study. OBJECTIVES: To validate a treatment plan by analyzing the clinical outcome of conservative treatment for patients with osteoporotic vertebral compression fractures at thoracolumbar junctions. SUMMARY OF LITERATURE REVIEW: Osteoporotic vertebral compression fractures, without neurological symptoms, have been treated by conservative management; however, serious sequelae of the osteoporotic vertebral compression fractures have been reported by many investigators. MATERIALS AND METHODS: We evaluated 83 cases; 68 patients had an average age of 71.1 years (58 to 99 years). After conservative treatment of the osteoporotic compression fractures, and based on the clinical outcome derived from a 10-point pain rating scale at last follow up, the group was sub-divided into two groups. Group A (N=28): had a score of above five points on the pain scale. Group B (N=55): had a score of less than five points on the pain scale. Evaluation of the correlation between the clinical outcome and factors affecting outcome such as vertebral body height loss, change in height loss, BMD and bracing were recorded at the initial and follow up assessment. RESULTS: The mean VAS score was 3.20+/-1.62, and the mean compression ratio was 24.74+/-12.03% at injury and 21.68+/-11.43% at the last follow-up. The mean compression ratio at injury was 27.67+/-10.50% in group A and 23.25+/-10.57% in group B. The mean compression ratio at the last follow-up was 53.43+/-13.31% for group A and 42.86+/-13.74% for group B. The change in compression ratio was 25.76+/-12.68% in group A and 19.60+/-10.25% in group B. The mean BMD was -3.63+/-1.16 for group A and -2.80+/-1.10 for group B. The compression ratio at last follow-up, change of compression ratio and BMD were significantly different in comparisons between group A and B (p=0.001, 0.031, 0.003, respectively). CONCLUSION: The clinical outcome of osteoporotic compression fractures was related to the compression ratio, and the compression ratio was related with BMD. Patients with osteoporotic compression fractures with a compression ratio of more than 30% and a T-score from the BMD of less than -3.5 require active treatment.